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Altaf J, Ashfaq AH, Riaz N, Arshad M, Ayub N, Rehman A, Maqbool S. Effect of hot saline irrigation on the operative field during endoscopic sinus surgery: a randomized controlled trial. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-09005-0. [PMID: 39354187 DOI: 10.1007/s00405-024-09005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 09/20/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND Control of bleeding is very important during endoscopic sinus surgery. Saline heated up to 50 °C causes dilatation of vessels and edema without nasal mucosa necrosis. It also promotes the clotting cascade so helps in having a bloodless procedure. METHODS AND MATERIALS This randomized controlled trial was conducted on 60 patients divided into two groups (30 each). Group A was the interventional group in which patients were irrigated with saline of 50 °C during surgery. Group B was the control group where room-temperature saline was used. The operative field was assessed using the Boezaart score, duration of surgery, and bleeding in ml. RESULTS The Boezaart score in group A came out to be 2.23 ± 0.72 whereas it was 3.43 ± 0.72 in group B. Most of the patients who were in the interventional group had their surgery completed within 60 min with comparatively less bleeding (mean bleeding = 221.83 ml). Patients of the control group had increased duration of surgery mostly and bleeding (mean = 265.67 ml). Our study showed a strong correlation amongst the Boezaart score, duration of surgery, and bleeding in ml with a p value of < 0.001 where all three variables significantly improved in the interventional group due to a good operative field provided by warm saline heated up to 50 °C. CONCLUSION Normal saline heated up to 50 °C is a cost-effective way to achieve a bloodless operative field during endoscopic sinus surgery. Reduced bleeding also decreases the duration of surgery.
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Affiliation(s)
- Jawairia Altaf
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Ahmed Hasan Ashfaq
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Nida Riaz
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Muhammad Arshad
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Nayyer Ayub
- HBS Medical and Dental College, Islamabad, Pakistan
| | - Abdur Rehman
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Shahzaib Maqbool
- Graduate of Rawalpindi Medical University, Rawalpindi, Pakistan.
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Bretherton D, Baker L, Eftekhar B. Optimal Temperature of Irrigation Fluid for Hemostasis in Neurosurgery: A Narrative Literature Review. J Neurol Surg A Cent Eur Neurosurg 2024; 85:405-411. [PMID: 37595630 DOI: 10.1055/a-2156-5285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
BACKGROUND Hemostasis in neurosurgery is crucial to patient and surgery outcomes, with many techniques developed for this. One area that is not appropriately characterized despite continuous anecdotal evidence the temperature of the irrigation fluid (IF) used and its effects on stemming hemorrhages. Given the ubiquitous use of IF in neurosurgery for clearing blood from the surgical field, it is important to explore its role as a hemostat and whether or not the temperature of the IF influences its hemostatic capacity. This review explored the literature for an optimal IF temperature for hemostasis in neurosurgery. METHODS Database searches were conducted using MEDLINE, Scopus, Web of Science, and CINAHL, with citation chaining occurring where applicable. Standard terms around neurosurgery, hemostasis, and irrigation were used. RESULTS Seven articles were identified. No optimal temperature for hemostasis could be confidently synthesized from the literature owing to lack of primary investigation on the subject. After collating available information into common themes, it is suggested that that temperatures >38°C are preferred. CONCLUSION The literature in this area is limited. Despite a lack of applicable systematic investigation on the topic, by exploring the physiology of hemostasis and IF, best practice guidelines for IF, and the literature on the role of the temperature of IF in other surgical specialties, it is suggested that a temperature in the range of 38 to 40°C would be most applicable to a value optimal for neurosurgery.
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Affiliation(s)
- Dylan Bretherton
- Department of Neurosurgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Lucy Baker
- Department of Neurosurgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Behzad Eftekhar
- Department of Neurosurgery, The University of Sydney, Sydney, New South Wales, Australia
- Department of Neurosurgery, Macquarie University, Sydney, New South Wales, Australia
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Sun D, Liang Y, Yang F, Liu L, Mao X, Xu X. Development and validation of a nomogram for predicting poor operative visibility during FESS in Chinese adult patients with CRS. Front Med (Lausanne) 2024; 11:1344661. [PMID: 38741764 PMCID: PMC11089246 DOI: 10.3389/fmed.2024.1344661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
Objective The purpose of this study is to develop and evaluate a nomogram that is capable of predicting poor operative visibility during functional endoscopic sinus surgery. Method To identify potential risk factors, patients with chronic rhinosinusitis who underwent functional endoscopic sinus surgery (FESS) between January 2019 and December 2022 were selected from our hospital's electronic medical record system. Data on general patient information, clinical manifestations, clotting-related test indices, Lund-Machay score of sinuses CT scanning, Lund-kennedy score of nasal endoscopies, anesthesia methods, intraoperative blood pressure and heart rate, and Boezaart bleeding score were collected. Minimum absolute convergence and selection operator (LASSO) regression, as well as multivariate logistic regression, were used to determine the risk factors. A nomogram was developed in order to predict poor operating visibility during FESS, and its performance was evaluated utilizing both the training and verification datasets via various measures including receiver operating characteristic (ROC) curve analysis, area under the curve (AUC), Hosmer-Lemeshow goodness-of-fit test, calibration curve, and decision curve analysis. Results Of the 369 patients who met the inclusion criteria, 88 of them exhibited POV during FESS. By deploying LASSO and multivariate logistic regression analyses, six risk factors were identified and used to construct a nomogram for predicting POV during FESS. These factors include prothrombin time (PT), prothrombin activity (PTA), Lund-Mackay score (LMS), Lund-Kennedy score (LKS), anesthetic method, and intraoperative hypertension. The AUC of the training set was found to be 0.820 while that of the verification set was 0.852. The Hosmer-Lemeshow goodness-of-fit test and calibration curve analysis revealed good consistency between predicted and actual probabilities. Also, the decision curve demonstrated that the nomogram had a high degree of clinical usefulness and net benefit. Conclusion The constructed nomogram has a strong ability to predict the poor intraoperative field in patients with chronic rhinosinusitis, which can help preoperative judgment of high-risk patients and provide evidence for perioperative management and preoperative plan formulation.
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Affiliation(s)
- Deping Sun
- Department of Otorhinolaryngology Head and Neck Surgery, The Fourth Clinical College of Chongqing Medical University, Chongqing, China
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Banasiewicz T, Machała W, Borejsza Wysocki M, Lesiak M, Krych S, Lange M, Hogendorf P, Durczyński A, Cwaliński J, Bartkowiak T, Dziki A, Kielan W, Kłęk S, Krokowicz Ł, Kusza K, Myśliwiec P, Pędziwiatr M, Richter P, Sobocki J, Szczepkowski M, Tarnowski W, Zegarski W, Zembala M, Zieniewicz K, Wallner G. Principles of minimize bleeding and the transfusion of blood and its components in operated patients - surgical aspects. POLISH JOURNAL OF SURGERY 2023; 95:14-39. [PMID: 38084044 DOI: 10.5604/01.3001.0053.8966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
One of the target of perioperative tratment in surgery is decreasing intraoperative bleeding, which increases the number of perioperative procedures, mortality and treatment costs, and also causes the risk of transfusion of blood and its components. Trying to minimize the blood loss(mainly during the operation) as well as the need to transfuse blood and its components (broadly understood perioperative period) should be standard treatment for a patient undergoing a procedure. In the case of this method, the following steps should be taken: 1) in the preoperative period: identyfication of risk groups as quickly as possible, detecting and treating anemia, applying prehabilitation, modyfying anticoagulant treatment, considering donating one's own blood in some patients and in selected cases erythropoietin preparations; 2) in the perioperative period: aim for normothermia, normovolemia and normoglycemia, use of surgical methods that reduce bleeding, such as minimally invasive surgery, high-energy coagulation, local hemostatics, prevention of surgical site infection, proper transfusion of blood and its components if it occurs; 3) in the postoperative period: monitor the condition of patients, primarily for the detection of bleeding, rapid reoperation if required, suplementation (oral administration preferred) nutrition with microelements (iron) and vitamins, updating its general condition. All these activities, comprehensively and in surgical cooperation with the anesthesiologist, should reduce the blood loss and transfusion of blood and its components.
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Affiliation(s)
- Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Waldemar Machała
- Klinika Anestezjologii i Intensywnej Terapii - Uniwersytecki Szpital Kliniczny im. Wojskowej Akademii Medycznej - Centralny Szpital Weteranów, Łódź
| | - Maciej Borejsza Wysocki
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Maciej Lesiak
- Katedra i Klinika Kardiologii Uniwersytetu Medycznego im. K. Marcinkowskiego w Poznaniu
| | - Sebastian Krych
- Katedra i Klinika Kardiochirurgii, Transplantologii, Chirurgii Naczyniowej i Endowaskularnej SUM. Studenckie Koło Naukowe Kardiochirurgii Dorosłych. Śląski Uniwersytet Medyczny w Katowicach
| | - Małgorzata Lange
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Hogendorf
- Klinika Chirurgii Ogólnej i Transplantacyjnej, Uniwersytet Medyczny w Łodzi
| | - Adam Durczyński
- Klinika Chirurgii Ogólnej i Transplantacyjnej, Uniwersytet Medyczny w Łodzi
| | - Jarosław Cwaliński
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Tomasz Bartkowiak
- Oddział Kliniczny Anestezjologii, Intensywnej Terapii i Leczenia Bólu, Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu
| | - Adam Dziki
- Klinika Chirurgii Ogólnej i Kolorektalnej Uniwersytetu Medycznego w Łodzi
| | - Wojciech Kielan
- II Katedra i Klinika Chirurgii Ogólnej i Chirurgii Onkologicznej, Uniwersytet Medyczny we Wrocławiu
| | - Stanisław Kłęk
- Klinika Chirurgii Onkologicznej, Narodowy Instytut Onkologii - Państwowy Instytut Badawczy im. Marii Skłodowskiej-Curie, Oddział w Krakowie, Kraków
| | - Łukasz Krokowicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Krzysztof Kusza
- Katedra i Klinika Anestezjologii i Intensywnej Terapii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Myśliwiec
- I Klinika Chirurgii Ogólnej i Endokrynologicznej, Uniwersytet Medyczny w Białymstoku
| | - Michał Pędziwiatr
- Katedra Chirurgii Ogólnej, Wydział Lekarski, Uniwersytet Jagielloński - Collegium Medicum, Kraków
| | - Piotr Richter
- Oddział Kliniczny Chirurgii Ogólnej, Onkologicznej i Gastroenterologicznej Szpital Uniwersytecki w Krakowie
| | - Jacek Sobocki
- Katedra i Klinika Chirurgii Ogólnej i Żywienia Klinicznego, Centrum Medyczne Kształcenia Podyplomowego, Warszawski Uniwersytet Medyczny, Warszawa
| | - Marek Szczepkowski
- Klinika Chirurgii Kolorektalnej, Ogólnej i Onkologicznej, Centrum Medyczne Kształcenia Podyplomowego, Szpital Bielański, Warszawa
| | - Wiesław Tarnowski
- Klinika Chirurgii Ogólnej, Onkologicznej i Bariatrycznej CMKP, Szpital im. Prof. W. Orłowskiego, Warszawa
| | | | - Michał Zembala
- Wydział Medyczny, Katolicki Uniwersytet Lubelski Jana Pawła II w Lublinie
| | - Krzysztof Zieniewicz
- Katedra i Klinika Chirurgii Ogólnej, Transplantacyjnej i Wątroby, Warszawski Uniwersytet Medyczny, Warszawa
| | - Grzegorz Wallner
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie
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Vuncannon JR, Wise SK. Hemostasis in endoscopic sinus and skull base surgery. Curr Opin Otolaryngol Head Neck Surg 2023; 31:33-38. [PMID: 36730664 DOI: 10.1097/moo.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Bleeding during endoscopic endonasal procedures can quickly obscure critical anatomic landmarks. This increases both the difficulty of the surgical procedure and the risk of complications faced by the patient. As the indications for surgical management of sinonasal pathology grow, it is important to review techniques to minimize bleeding and facilitate safe surgery. RECENT FINDINGS Evidence continues to accumulate for best practices in the surgical management of sinonasal disease. Recently, international guidelines have attempted to summarize this body of evidence, lending further support to several interventions which have been advocated as methods to decrease bleeding during endoscopic endonasal surgery. Additional studies have specifically investigated the safety of certain commonly employed techniques. The utility of preoperative corticosteroid therapy and the use of total intravenous anesthetic techniques in increasingly validated. Further evidence supports the safety of reverse Trendelenburg positioning for surgical management of inflammatory disease. SUMMARY Recent wide scale systematic review of the literature regarding perioperative and intraoperative management of hemostasis has reinforced the utility of certain interventions, while others remain ambiguous.
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Affiliation(s)
- Jackson R Vuncannon
- Emory University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Atlanta, GA
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Alsaadi N, Hassoune A, Haldeman S, Williamson KM, Plautz W, Hoteit L, Alvikas J, Andraska EA, Srinivasan AJ, Bonaroti J, Seshadri A, Mota-Alvidrez R, Scott MJ, Gardner PA, Snyderman CH, Neal MD. EFFECT OF IRRIGATION FLUID COMPOSITION ON HEMOSTASIS IN MOUSE BLEEDING MODELS. Shock 2022; 58:549-555. [PMID: 36399097 PMCID: PMC9789188 DOI: 10.1097/shk.0000000000002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/22/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022]
Abstract
ABSTRACT Introduction: Intraoperative irrigation, usually with normal saline (NS), aids in bleeding identification and management. We investigated the effect of different irrigation fluids, with additives, on hemostasis using two bleeding models. Methods: C57BL/6 J mice were subjected to a tail bleed model or uncontrolled abdominal hemorrhage via liver laceration followed by abdominal cavity irrigation. We compared NS, lactated Ringer's (LR), and PlasmaLyte. We examined NS and LR at different temperatures. Normal saline or LR with calcium (Ca 2+ ) or tranexamic acid (TXA) was studied. Results: Compared with room temperature (RT), increasing the temperature of the irrigation fluid to 37°C and 42°C reduced tail vein bleeding times substantially in both NS and LR (all P < 0.001), with no significant differences between the two fluids. At RT, LR, but not PlasmaLyte, substantially reduced bleeding times in comparison to NS ( P < 0.0001). Liver injury blood loss was lower with LR ( P < 0.01). Normal saline supplemented with 2.7 mEq/L of Ca 2+ decreased bleeding time and blood loss volume ( P < 0.001 and P < 0.01, respectively) to similar levels as LR. Normal saline with 150 mg/mL of TXA markedly reduced bleeding time ( P < 0.0001), and NS with 62.5 mg/mL TXA decreased blood loss ( P < 0.01). Conclusion: Whereas Ca 2+ - and TXA-supplemented NS reduced bleeding, LR remained superior to all irrigation fluid compositions. As LR contains Ca 2+ , and Ca 2+ -supplemented NS mirrored LR in response, Ca 2+ presence in the irrigation fluid seems key to improving solution's hemostatic ability. Because warming the fluids normalized the choice of agents, the data also suggest that Ca 2+ -containing fluids such as LR may be more suitable for hemostasis when used at RT.
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Affiliation(s)
- Nijmeh Alsaadi
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adnan Hassoune
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shannon Haldeman
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kelly M. Williamson
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William Plautz
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lara Hoteit
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jurgis Alvikas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth A. Andraska
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amudan J. Srinivasan
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jillian Bonaroti
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anupamaa Seshadri
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roberto Mota-Alvidrez
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melanie J. Scott
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul A. Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carl H. Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Matthew D. Neal
- Pittsburgh Trauma & Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Nagarajah D, Kueh YC, Lazim NM, Abdullah B. The hemostatic effect of hot saline irrigation in endoscopic sinus surgery: a systematic review and meta-analysis. Syst Rev 2022; 11:246. [PMID: 36401259 PMCID: PMC9675124 DOI: 10.1186/s13643-022-02113-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A good control of intraoperative bleeding is key for adequate anatomical visualization during endoscopic sinus surgery (ESS). The objective of this review was to assess the practice of hot intranasal saline irrigation (HSI) in achieving intraoperative hemostasis and good surgical field quality during ESS. METHODS An electronic search was performed via PubMed, SCOPUS, Google Scholar, and Cochrane from inception to June 2022. The included trials were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews. The primary outcome assessed was the intraoperative bleeding score of the surgical field. The mean arterial pressure, duration of the surgery, amount of blood loss and surgeon's satisfaction score were assessed as the secondary outcomes. The risk of bias for each study was evaluated using the Cochrane risk of bias tool. RESULTS A total of 254 records were identified after removal of duplicates. Based on the title and abstract 246 records were excluded, leaving seven full texts for further consideration. Five records were excluded following full text assessment. Three trials with a total of 212 patients were selected. Hot saline irrigation was superior to control in the intraoperative bleeding score (MD - 0.51, 95% CI - 0.84 to - 0.18; P < 0.001; I2 = 72%; very low quality of evidence) and surgeon's satisfaction score (RR 0.18, 95% CI 0.09 to 0.33; P < 0.001; I2 = 0%; low quality of evidence). The duration of surgery was lengthier in control when compared to HSI (MD - 9.02, 95% CI - 11.76 to - 6.28; P < 0.001; I2 = 0; very low quality of evidence). The volume of blood loss was greater in control than HSI (MD - 56.4, 95% CI - 57.30 to - 55.51; P < 0.001; I2 = 0%; low quality of evidence). No significant difference between the two groups for the mean arterial pressure was noted (MD - 0.60, 95% CI - 2.17 to 0.97; P = 0.45; I2 = 0%; low quality of evidence). CONCLUSIONS The practice of intranasal HSI during ESS is favorable in controlling intraoperative bleeding and improving the surgical field quality. It increases the surgeon's satisfaction, reduces blood loss, shortens operative time and has no effect on intraoperative hemodynamic instability. TRIAL REGISTRATION PROSPERO registration number: CRD42019117083.
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Affiliation(s)
- Darshini Nagarajah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Yee Cheng Kueh
- Unit Biostatistic and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Norhafiza Mat Lazim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
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Overview of Pituitary Surgery. Otolaryngol Clin North Am 2022; 55:205-221. [DOI: 10.1016/j.otc.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Moldovan H, Antoniac I, Gheorghiță D, Safta MS, Preda S, Broască M, Badilă E, Fronea O, Scafa-Udrişte A, Cacoveanu M, Molnar A, Costache VS, Zaharia O. Biomaterials as Haemostatic Agents in Cardiovascular Surgery: Review of Current Situation and Future Trends. Polymers (Basel) 2022; 14:1189. [PMID: 35335519 PMCID: PMC8955858 DOI: 10.3390/polym14061189] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
Intraoperative haemostasis is of paramount importance in the practice of cardiovascular surgery. Over the past 70 years, topical haemostatic methods have advanced significantly and today we deal with various haemostatic agents with different properties and different mechanisms of action. The particularity of coagulation mechanisms after extracorporeal circulation, has encouraged the introduction of new types of topic agents to achieve haemostasis, where conventional methods prove their limits. These products have an important role in cardiac, as well as in vascular, surgery, mainly in major vascular procedures, like aortic dissections and aortic aneurysms. This article presents those agents used for topical application and the mechanism of haemostasis and offers general recommendations for their use in the operating room.
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Affiliation(s)
- Horațiu Moldovan
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Iulian Antoniac
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania;
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania;
| | - Maria Sabina Safta
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Silvia Preda
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Marian Broască
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
| | - Elisabeta Badilă
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Oana Fronea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Alexandru Scafa-Udrişte
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Mihai Cacoveanu
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
| | - Adrian Molnar
- Faculty of Medicine, Iuliu Hateganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
- Heart Institute, 400001 Cluj-Napoca, Romania
| | - Victor Sebastian Costache
- Sf. Constantin Hospital, 500388 Brasov, Romania;
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Ondin Zaharia
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
- Prof.Dr. Theodor Burghele Clinical Hospital, 050659 Bucharest, Romania
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10
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Fan T, Workman AD, Gray ST. Surgical Considerations in Endoscopic Pituitary Approaches for the Otolaryngologist. Otolaryngol Clin North Am 2022; 55:381-388. [DOI: 10.1016/j.otc.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Afzalzadeh M, Khademi S, Kazemi A, Divanbeigi R. A review of the revisions and complications management procedure in sinus surgery. J Family Med Prim Care 2022; 11:887-895. [PMID: 35495831 PMCID: PMC9051709 DOI: 10.4103/jfmpc.jfmpc_897_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
One of the most standard and least invasive surgical procedures that could be applied mostly for the treatment of inflammation of the paranasal sinuses is endonasal endoscopic sinus surgery. The main objective of this study is to assess the available strategies for avoiding, diagnosis and also dealing with various kinds of potential complications of sinus disorders as well as the symptoms which specify the need for revision endoscopic sinus surgery mainly for the treatment of chronic rhinosinusitis. Based on the objectives of this study, the studies were categorized within four main groups; sinus disorders, diagnosis, management, and treatment. In this regard, wide research has been done in various scientific databases of PubMed, EMBASE, Europe PMC, HubMed, MEDLINE, Scientific Information Database (SID) and Google Scholar. From a total of 315 founded records, the final number of 91 records were reviewed. The rate of complication associated with endoscopic sinus surgery is not much and the improvement of surgical technology and experience could decrease its side effects. Performing immediate extensive surgery among patients who have inflammatory sinonasal disease could modify long-term consequences. Applying endoscopic sinus surgery could yield the most appropriate positive outcomes. For achieving the most suitable surgical consequences, the surgeon should be adequately qualified in diagnosis and facing with any possible complications during the operation in addition to cases with complex and revision problems.
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12
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Nordström A, Jangard M, Svedberg M, Kullenberg H, Ryott M, Kumlin M. Hot saline irrigation in comparison to nasal packing after sinus surgery. Laryngoscope Investig Otolaryngol 2021; 6:1267-1274. [PMID: 34938861 PMCID: PMC8665458 DOI: 10.1002/lio2.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Previous studies have shown that hot saline solution (HSS) nasal irrigation is effective against nasal bleeding and is used to treat nasal hemorrhage. In a pilot study, we evaluated hot saline nasal irrigation in comparison to a routinely used nasal packing in terms of self-reported complications and mucosal healing after functional endoscopic sinus surgery. METHODS Patients undergoing surgery for bilateral chronic rhinosinusitis received polyvinyl acetate (PVA) nasal packing in the left nostril, and the right nostril was rinsed with 47°C sterile saline immediately after surgery. Patients' experiences of pain, bleeding, and other types of uncomfortable experiences were measured using a visual analog scale for each nostril before, during, and immediately after nasal packing removal. Two weeks post-surgery, the assessments were repeated including an endoscopic evaluation of the mucosa by the surgeon. RESULTS Twenty-seven patients completed the study. Prior to removal of the packing, the patients experienced significantly more pain and other uncomfortable experiences in the nostril treated with nasal packing, as compared to the nostril solely rinsed with hot saline. After removal, patients reported significantly more uncomfortable experiences from the packing treated nostril. Two weeks post-surgery, no difference in mucosal healing was observed between the two nostrils. CONCLUSIONS The results from this study indicate that irrigation with HSS could be an alternative postoperative treatment to conventional PVA nasal packing. Hot saline irrigation may contribute to patients experiencing improved control of postoperative bleeding, pain, and less suffering of other causes as well as health-economic benefits, without affecting the mucosal healing up to 2 weeks post-surgery. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Axel Nordström
- Department of Health Promotion ScienceSophiahemmet UniversityStockholmSweden
| | - Mattias Jangard
- Department of OtorhinolaryngologySophiahemmet HospitalStockholmSweden
| | - Marie Svedberg
- Department of Health Promotion ScienceSophiahemmet UniversityStockholmSweden
| | - Helena Kullenberg
- Department of Health Promotion ScienceSophiahemmet UniversityStockholmSweden
| | - Michael Ryott
- Department of OtorhinolaryngologySophiahemmet HospitalStockholmSweden
| | - Maria Kumlin
- Department of Health Promotion ScienceSophiahemmet UniversityStockholmSweden
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13
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Hot Saline Irrigation for Haemostasis in Functional Endoscopic Sinus Surgery: A Systematic Review and Meta-analysis. The Journal of Laryngology & Otology 2021; 136:676-682. [PMID: 34819186 DOI: 10.1017/s0022215121003698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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14
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The effect of intranasal irrigation with epinephrine solution on intraoperative visualization and bleeding during FESS. Eur Arch Otorhinolaryngol 2021; 279:1911-1917. [PMID: 34175968 DOI: 10.1007/s00405-021-06952-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Bleeding during Functional endoscopic sinus surgery (FESS) can have adverse effect on surgical outcomes. This study evaluates if there is any benefit of adding epinephrine to the saline nasal irrigation in patients undergoing elective FESS for chronic rhinosinusitis. METHODS A prospective, randomized, double-blinded study was performed. Fifty ASA I or II patients undergoing FESS were randomized to have irrigation either with normal saline or (1:100,000) epinephrine in normal saline during surgery. Outcomes measure included the Boezaart grading scale to assess the intraoperative surgical field, surgeon's satisfaction with field visualization and bleeding which was evaluated in a 10 cm visual analog scale, estimated blood loss as well as hemodynamic parameters changes. RESULTS There was no statistically significant difference in the studied variables between both groups. However in patients with higher than 12 Lund-Mackay score the volume of blood loss was significantly less in the epinephrine group. All surgical procedures were completed and there were no operative complications or any reported perioperative cardiovascular events. CONCLUSIONS Intraoperative irrigation with saline-epinephrine solution at a concentration of (1:100,000) is safe and does not change heart rate or blood pressure but is unlikely to improve the setting of intraoperative surgical field except for decreasing the volume of blood loss in patients with high Lund-Mackay score.
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15
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Khanwalkar AR, Welch KC. Updates in techniques for improved visualization in sinus surgery. Curr Opin Otolaryngol Head Neck Surg 2021; 29:9-20. [PMID: 33315617 DOI: 10.1097/moo.0000000000000693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Adequate visualization during endoscopic sinus surgery (ESS) is one of the most critical aspects of performing well tolerated and successful surgery. The topic of visualization encompasses a broad spectrum of preoperative and intraoperative manoeuvres the surgeon can perform that aid in the understanding of the patient's anatomy and in the delivery of efficient surgical care. RECENT FINDINGS Preoperative considerations to improve visualization include optimization of haemostasis through management of comorbidities (e.g. hypertension, coagulopathies), medication management (e.g. blood thinners) and systemic versus topical corticosteroids. New technologies allow preoperative visual mapping of surgical plans. Advances in knowledge of intraoperative anaesthesia have encouraged a move toward noninhaled anaesthetics to reduce bleeding. High definition cameras, angled endoscopes, 3D endoscopes and more recently augmented reality, image-guided surgery, and robotic surgery, represent the state of the art for high-quality visualization. Topical interventions, such as epinephrine, tranexamic acid and warm isotonic saline, can help to reduce bleeding and improve the operative field. Surgical manoeuvres, such as polyp debulking, septoplasty, carefully controlled tissue manipulation and a consistent repeatable approach remain fundamental to appropriate intraoperative surgical visualization. SUMMARY This chapter delineates medical, technical and technological means - preoperatively and intraoperatively - to achieve optimized visualization of the surgical field in ESS.
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Affiliation(s)
- Ashoke R Khanwalkar
- Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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16
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Hanson M, Li H, Geer E, Karimi S, Tabar V, Cohen MA. Perioperative management of endoscopic transsphenoidal pituitary surgery. World J Otorhinolaryngol Head Neck Surg 2020; 6:84-93. [PMID: 32596652 PMCID: PMC7296486 DOI: 10.1016/j.wjorl.2020.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/19/2020] [Indexed: 11/12/2022] Open
Abstract
The contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery. Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care. Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients. The many areas of potential variability in the pre, intra and post-operative timeline of pituitary surgery are readily identifiable. Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.
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Affiliation(s)
- Martin Hanson
- Multidisciplinary Pituitary and Skull Base Tumour Program, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Hao Li
- Multidisciplinary Pituitary and Skull Base Tumour Program, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Eliza Geer
- Multidisciplinary Pituitary and Skull Base Tumour Program, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Sasan Karimi
- Multidisciplinary Pituitary and Skull Base Tumour Program, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Viviane Tabar
- Multidisciplinary Pituitary and Skull Base Tumour Program, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Marc A Cohen
- Multidisciplinary Pituitary and Skull Base Tumour Program, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
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17
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Omura K, Hosokawa Y, Nomura K, Aoki S, Tochigi K, Miyashita K, Tanaka Y, Otori N, Kojima H. Effect of gauze placement soaked with adrenaline at suprabullar recess on hemostasis during endoscopic sinus surgery: A randomized controlled trial. Head Neck 2020; 42:2397-2404. [PMID: 32385867 DOI: 10.1002/hed.26243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/09/2020] [Accepted: 04/22/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Topical application of vasoconstrictors is necessary for endoscopic sinus surgery (ESS) for a bloodless surgical view and reduced intraoperative bleeding. We aimed to verify the effectiveness of gauze placement soaked with adrenaline at suprabullar recess, where the anterior ethmoidal artery exists, on hemostasis during ESS. METHODS A randomized, double-blinded trial was carried out for 26 patients receiving ESS. At the beginning of the surgery, gauze soaked with 2% lidocaine with or without 1:10 000 adrenaline was placed at the suprabullar recess for 8 minutes. Estimated blood loss, surgical field score, and operation time were compared between the two groups. RESULTS Estimated blood loss and surgical field score were significantly smaller in the adrenaline group than in the no adrenaline group. Operation time was not significantly different between the two groups. CONCLUSION Gauze placement soaked with adrenaline at suprabullar recess reduces estimated blood loss and clears the surgical field during ESS.
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Affiliation(s)
- Kazuhiro Omura
- Department of Otolaryngology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
| | - Yu Hosokawa
- Department of Otolaryngology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai-shi, Miyagi, Japan
| | - Satoshi Aoki
- Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
| | - Kosuke Tochigi
- Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
| | - Keisuke Miyashita
- Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
| | - Yasuhiro Tanaka
- Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
| | - Nobuyoshi Otori
- Department of Otolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otolaryngology, The Jikei University School of Medicine, Tokyo, Japan
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18
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Ceylan SM, Dişikırık İ, Kanmaz MA, Yıldırım A, Sezgin E. Hot nasal packing with hot saline irrigation for hemostasis after adenoidectomy: A prospective randomized controlled study. Int J Pediatr Otorhinolaryngol 2020; 130:109792. [PMID: 31809970 DOI: 10.1016/j.ijporl.2019.109792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the efficacy of hot posterior nasal packing and hot saline irrigation in bleeding control after adenoidectomy. METHODS A total of 130 patients scheduled for adenoidectomy were included in the study, and randomized into two groups at the beginning of the surgical operation. After adenoidectomy, saline impregnated tampon, and saline irrigation at room temperature (22 °C) was applied to the patients in one group while 50 °C saline impregnated tampon and saline irrigation at the same temperature were applied to the patients in the other group. We recorded hemostasis for up to 3 min after tamponade for bleeding control, and the amount of bleeding into the nasopharynx. RESULTS The age of the patients ranged from 1.5 to 13 years (mean ± SD: 6.07 ± 3.08 years, and 5.33 ± 2.55 years, 22 °C and 50 °C saline irrigation groups, respectively). There were 37 males and 28 females in the 22 °C saline group, while 34 males and 31 females in the 50 °C saline group. When comparing the two groups, there was no statistically significant difference in terms of duration of hemostasis (p = 0.64). However, bleeding scores at 2 nd min after the tamponade were significantly lower in the 50 °C saline group (p = 0.007). The amount of bleeding in the 50 °C saline group was also significantly lower than the 22 °C saline group (p = 0.015). CONCLUSION In this study, application of 50 °C saline impregnated tampon, and hot saline irrigation was found to be more effective in the control of bleeding after adenoidectomy by reducing the amount of bleeding compared to 22 °C saline impregnated tampon application and saline irrigation at 22 °C. However, hot nasal packing and hot saline irrigation did not affect duration of hemostasis and cauterization.
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Affiliation(s)
- Seyit Mehmet Ceylan
- Department of Otorhinolaryngology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - İlyas Dişikırık
- Department of Otorhinolaryngology, Faculty of Medicine, SANKO University, Gaziantep, Turkey.
| | - Mahmut Alper Kanmaz
- Department of Ear Nose Throat Disease, Sani Konukoğlu Hospital Practice and Research Center, Gaziantep, Turkey.
| | | | - Efe Sezgin
- Laboratory of Nutrigenomics and Epidemiology, Department of Food Engineering, İzmir Institute of Technology, İzmir, Turkey.
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19
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Alsaleh S, Manji J, Javer A. Optimization of the Surgical Field in Endoscopic Sinus Surgery: an Evidence-Based Approach. Curr Allergy Asthma Rep 2019; 19:8. [PMID: 30712131 DOI: 10.1007/s11882-019-0847-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The advent of endoscopic sinus surgery (ESS) has enabled the development of minimally invasive surgical procedures in Rhinology. However, proficiency with ESS techniques can still be hampered by poorly controlled bleeding limiting visibility of the surgical field (VSF). This can lead to increased operating time and, more importantly, increased risk of major and minor complications. To optimize the VSF and mitigate the risk of complications, many strategies have been explored. RECENT FINDINGS This is a narrative review of the relative risks and benefits of pre- and intra-operative interventions aimed at optimizing intraoperative conditions during ESS. The value of these interventions is determined based on their impact on intraoperative blood loss, time of surgery, and the VSF, and weighed against their adverse event profile. This review provides a comprehensive overview of the evidence relating to the safety and efficacy of interventions used to improve intraoperative conditions during ESS.
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Affiliation(s)
- Saad Alsaleh
- Otolaryngology - Head and Neck Surgery Department, College of Medicine, King Saud University Medical City, PO Box 245, Riyadh, 11411, Saudi Arabia.
- St. Paul's Sinus Centre, Vancouver, BC, Canada.
| | - Jamil Manji
- St. Paul's Sinus Centre, Vancouver, BC, Canada
| | - Amin Javer
- St. Paul's Sinus Centre, Vancouver, BC, Canada
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20
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Abstract
PURPOSE OF REVIEW Endoscopic skull base surgery has become an established approach for the removal of tumors and cerebrospinal fluid fistulae repair. Compared with external approaches, it provides better aesthetic results and quality of life postoperatively. However, as it becomes popular and expands its indications possible complications should be reassessed in terms of incidence and variability in order to confirm its efficacy and safety. This article reviews the recent literature describing the main categories of possible complications suggesting strategies to minimize their incidence. RECENT FINDINGS Detailed preoperative planning based on imaging and histology can prevent major complications. Intraoperative use of image guidance and meticulous hemostasis provide the surgical field needed to avoid complications. Postoperative patient counseling, along with close and detailed nasal postoperative care are significant factors for an optimal outcome. SUMMARY Monitoring of complications after endoscopic skull base surgery is necessary in order to standardize protocols of management and improve our surgical techniques. The presence of late onset complications underlines the need of a special focus in postoperative care and follow-up.
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21
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Abstract
Many patients with severe epistaxis benefit from endoscopic intervention for control of bleeding. Critical maneuvers to improve endoscopic visualization during surgery include head-of-bed elevation, application of topical vasoconstrictors, and local injection of vasonstrictors. Controlled, hypotensive anesthesia may also decrease intraoperative blood loss and improve visualization during surgery. Intractable posterior epistaxis can be controlled with high rates of success with endoscopic sphenopalatine artery ligation. Although less common, intractable anterior epistaxis may be controlled by anterior ethmoid artery ligation once this artery is identified as the primary source. Less common sources of severe epistaxis are also discussed in this article.
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Affiliation(s)
- Giant Lin
- Advocare Aroesty Ear, Nose, and Throat Associates, 400 Valley Road, Suite 105, Mount Arlington, NJ 07856, USA
| | - Benjamin Bleier
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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22
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Abstract
Intraoperative bleeding during endoscopic sinus surgery poses an additional dimension to an already technically challenging surgical approach because of the narrow sinonasal surgical field, single working hand, and the use of endoscopic instruments. Poor visualization is one of the most important factors that increase the risk of intraoperative complications such as inadvertent injury to major vessels and nerves, and incomplete surgery. This article provide a logical approach to improving the surgical field, minimizing risk of inadvertent vascular injury, and managing intraoperative bleeding.
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Affiliation(s)
- Harshita Pant
- Department of Otolaryngology, Head and Neck Surgery, University of Adelaide School of Medicine, Frome Road, Adelaide, SA 5005, Australia.
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23
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R Baylis J, Finkelstein-Kulka A, Macias-Valle L, Manji J, Lee M, Levchenko E, Okpaleke C, Al-Salihi S, Javer A, J Kastrup C. Rapid hemostasis in a sheep model using particles that propel thrombin and tranexamic acid. Laryngoscope 2016; 127:787-793. [PMID: 27861945 DOI: 10.1002/lary.26408] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS Bleeding during endoscopic sinus surgery and open surgeries can easily obstruct the surgeons' field of view and increase morbidity and risk of intraoperative complications. Intraoperative bleeding could potentially be addressed by a hemostatic agent that safely disperses itself through the escaping blood. We tested the safety and efficacy of a self-propelling formulation of thrombin and tranexamic acid (SPTT) in stopping bleeding in a paranasal sinus injury and in an open surgical carotid injury sheep model. STUDY DESIGN Interventional animal study. METHODS SPTT was tested in the sinonasal space following endoscopic injury to the inferior turbinate of six sheep, and to the common carotid artery following open surgical injury in eight sheep. In the nasal cavity, bleeding time and local inflammation were measured and compared to plain gauze. Following carotid arteriotomy, successful hemostasis and markers of thrombosis and coagulopathy were compared to Floseal. RESULTS SPTT significantly decreased bleeding times in the sinonasal space compared to plain gauze (mean difference = 3.8 minutes, P = .002). All of the carotid bleeds (100%) were successfully controlled with SPTT after 10 minutes of application under pressure, compared to 25% with Floseal. No adverse events were noted, and there was no evidence of thromboembolism. CONCLUSIONS SPTT significantly reduced bleeding time in a sheep model of surgical sinus bleeding and successfully stopped bleeding following catastrophic carotid artery injury, with no adverse events observed. LEVEL OF EVIDENCE NA Laryngoscope, 127:787-793, 2017.
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Affiliation(s)
- James R Baylis
- Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andres Finkelstein-Kulka
- St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Luis Macias-Valle
- St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile.,Hospital Espñol de México, Facultad Mexicana de Medicina, Universidad La Salle, Mexico City, Mexico
| | - Jamil Manji
- St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Michael Lee
- Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elina Levchenko
- Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Okpaleke
- St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Salahuddin Al-Salihi
- St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Amin Javer
- St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Christian J Kastrup
- Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
PURPOSE OF REVIEW Optimization of the surgical field involves a complex interplay of many factors. Although it is agreed that hemostasis is critical to safe, efficient, and successful sinus surgery, a lack of consensus exists as to the best way to achieve it. This review examines the current body of evidence supporting many of the practices surgeons believe to influence hemostasis. RECENT FINDINGS Although many of the practices discussed in this article have long been considered to influence hemostasis, it is not until recently that high-level evidence supporting their use has been available. Well designed studies now exist supporting the preoperative use of oral steroids in polyp patients, the importance of adequate reverse trendelenburg positioning, the use of flexible laryngeal mask ventilation during general anesthesia, and the increased safety and comparable efficacy of topical epinephrine over other topical and injectable agents. Controversy still exists as to the ideal method of achieving controlled hypotensive anesthesia, although new evidence has emerged as to what hemodynamic parameters should be adhered to, to reduce the risk of cerebral hypoperfusion. SUMMARY Numerous factors influence hemostasis and so it is important that ENT surgeons have a sound understanding of the evidence supporting their everyday surgical practice. Improved standardization of scoring and reporting of bleeding may increase the power of research studies to draw more definitive conclusions about the role that certain factors have on hemostasis.
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25
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Stokken JK, Halderman A, Recinos PF, Woodard TD, Sindwani R. Strategies for Improving Visualization During Endoscopic Skull Base Surgery. Otolaryngol Clin North Am 2016; 49:131-40. [PMID: 26614833 DOI: 10.1016/j.otc.2015.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The nasal cavity has a robust vascular supply, and bleeding is a primary obstacle to the minimally invasive skull base technique. Venous bleeding, including the cavernous sinus, can be managed with various techniques using hemostatic materials and pressure. A thorough understanding of the skull base vascular anatomy is vital for avoiding injury to major arteries and having confidence to control venous bleeding to optimize the endoscopic view and tumor resection.
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Affiliation(s)
- Janalee K Stokken
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Ashleigh Halderman
- Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, USA
| | - Pablo F Recinos
- Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Troy D Woodard
- Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Raj Sindwani
- Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, USA; Minimally Invasive Cranial Base and Pituitary Surgery Program, Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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26
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Korkmaz H, Yao W, Korkmaz M, Bleier BS. Benefit of Preoperative Oral Steroids during Sinus Surgery when Utilizing Concentrated Topical Epinephrine. ORL J Otorhinolaryngol Relat Spec 2016; 78:216-22. [PMID: 27383647 DOI: 10.1159/000446806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/13/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Oral steroids have been advocated in the preoperative setting as a means of reducing intraoperative blood loss and surgical time during sinus surgery. The purpose of this study was to analyze the impact of preoperative oral steroid administration on intraoperative bleeding and surgical duration when coupled with concentrated topical epinephrine. METHODS The medical records of 302 patients who underwent bilateral 'full house' sinus surgery were reviewed. Concentrated topical epinephrine and inhalational anesthesia was used in all patients. Surgical duration and estimated blood loss were compared between the preoperative steroid-exposed and steroid-naive groups. χ2 and Student's t tests were used for statistical analysis. RESULTS One hundred and forty-two patients were exposed to steroid, while the remaining 160 were steroid naive. No significant differences were found with respect to surgical time between the steroid-exposed (96.91 ± 25.97 min) and steroid-naive patients (91.24 ± 32.29 min, p = 0.100). The steroid-exposed group demonstrated a marginally increased blood loss (66.03 ± 55.81 ml) as compared to steroid-naive patients (55.00 ± 38.71 ml, p = 0.048). CONCLUSION When coupled with intraoperative concentrated topical epinephrine use, preoperative oral steroid administration provides no clinically significant benefit with respect to reduced intraoperative bleeding or surgical duration.
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Affiliation(s)
- Hakan Korkmaz
- Otorhinolaryngology Department, Ordu University Faculty of Medicine, Ordu, Turkey
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Haraji A, Rakhshan V, Hosseini V. Local heating of the wound with dressings soaked in saline at 42°C can reduce postoperative bleeding: a single-blind, split-mouth, randomised controlled clinical trial. Br J Oral Maxillofac Surg 2016; 54:266-9. [DOI: 10.1016/j.bjoms.2016.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 01/16/2016] [Indexed: 10/22/2022]
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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Abstract
Complications of endoscopic sinus surgery (ESS) can range from the mundane to the catastrophic, with nasal hemorrhage being the most common. Intraorbital and intracranial complications are much less common. Despite the rarity of complications, they are often avoidable. Certain identifiable risk factors can be appreciated during the preoperative, intraoperative, and postoperative evaluations of the sinus patient. With awareness of these risk factors the rhinologist can develop a strategic plan of risk factor mitigation. This article identifies areas of increased risk that are amenable to preventive strategies before complications become realized.
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Affiliation(s)
- Ian M Humphreys
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
| | - Peter H Hwang
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA
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Smith TL. Chronic rhinosinusitis. Int Forum Allergy Rhinol 2014; 4:859-60. [PMID: 25330978 DOI: 10.1002/alr.21441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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